Chronic low back pain, depression, and attributional style

Twenty consecutive, chronic low back pain patients admitted to our pain treatment unit completed the Attributional Style Questionnaire (an instrument that detects a cognitive style that is correlated with, and that predicts, depression) and the Beck Depression Inventory. An age, sex, and education-matched group of normal subjects, a group of patients with asymptomatic essential hypertension, and a group of patients with end-stage renal disease receiving dialysis treatment served as controls. The majority of the chronic-pain and renal-dialysis patients had elevated depression scores, whereas none of the normal subjects or hypertensive patients were outside the nondepressed range. The Attributional Style scores of the pain and renal dialysis patients were significantly deviant from the normal control group, but no more so than those of the patients with hypertension. The results of this study suggest that individuals with a chronic medical condition, either symptomatic (chronic low back pain or renal disease) or asymptomatic (essential hypertension) in nature, develop an attributional style characteristic of depression. These data neither lend support nor refute the thesis that chronic pain syndromes are a variant of, or a masked, depression. Rather, this research implies that a more important question is what identifiable risk factors (for example, attributional style) predispose patients with chronic pain to develop a depressive illness.     

Stress and attributional style as predictors of self-reported depression in children

Attributional approaches to depression, such as hopelessness theory (Abramson, Metalsky, & Alloy, 1989), suggest that a stable, global attributional style for negative events combined with failure to achieve a highly valued outcome will lead to depression. The current study assessed the ability of the interaction of attributional style and daily negative events to predict self-reported depression in children. Eighty-four children between the ages of 9 and 12 participated in this longitudinal study. Self-reported depression symptoms were assessed before and after exposure to stressful events. The data analysis consisted of stepwise hierarchical multiple-regression procedures. While attributional style alone did not predict change in self-reported depression symptoms following stressful events, the interaction of attributional style with stress did predict them. Stress predicted depression symptoms as well.This paper was based on the dissertation of J. Faye Dixon under the direction of Anthony Ahrens at The American University. Portions of this research were presented at the Midwestern Psychological Association Convention, Chicago, May 1991. We wish to thank Rebecca del Carmen, Mary Parpal, and Jon Rolf for their service as members of the dissertation committee. Further thanks go to Trail Blazers Camp for their cooperation in the collection of these data. Thanks also go to Emily Hauck, Dave Jobes, and Maureen Lyon for their help in coding data, and to Constance Hammen and three anonymous reviewers for their helpful comments on a prior draft of this paper.     

Bulimic symptoms and the development of depressive symptoms: The moderating role of attributional style

Using a prospective design, we examined whether attributional style moderated the relationship between the presence of bulimic symptoms and subsequent increases in depressive symptoms. As predicted, the presence of bulimic symptoms in college females at one point in time (T1) was associated with increases in depressive symptoms from T1 to T2 (3 weeks after T1) for subjects who exhibited a negative attributional style, but not for subjects who exhibited a positive attributional style. Depressive symptoms at T1 were not associated with increases in bulimic symptoms from T1 to T2. Of importance to the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), the presence of bulimic symptoms alone did not predict onset of depressive symptoms; it was only when bulimic symptoms and the negative attributional style were combined that depressive symptoms emerged. The hypothesis that these effects would be mediated by hopelessness obtained marginal support, and effects were obtained for depressive and anhedonic symptoms but not for anxious symptoms. We discussed implications for future work, including the value of the hopelessness theory of depression in explaining the co-occurrence of depressive and bulimic symptoms.Preparation of this article was supported, in part, by a Young Investigator Award to Thomas Joiner from the National Alliance for Research on Schizophrenia and Affective Disorders (NARSAD); by a research grant to Thomas Joiner from the University of Texas Medical Branch at Galveston, the funds of which derive from the Pearl and Aaron Forman Research Foundation and the John Sealy Memorial Endowment Fund; by a grant from the Hogg Foundation for Mental Health to G. I. Metalsky; and by a Public Health Service Biomedical Research Support Grant (2 S07 RR05407-28) to S. A. Wonderlich.     

The specificity of attributional style and expectations to positive and negative affectivity,depression, and anxiety

Ninety-four undergraduate subjects completed measures of trait positive and negative affectivity, anxiety, depression, optimism, hopelessness, and attributional style. After writing about negative events or hearing a tape describing a positive academic experience, they completed measures of state positive and negative affect and of self-efficacy expectancies. Positive affectivity was associated with attributional style for positive, but not negative, events. Negative affectivity was associated with attributional style for negative, but not positive, events. Negative event attributional style was specifically associated with anxiety; expectancies and positive event attributional style with depression. Attributional style predicted state positive affect following completion of negative essays, but not negative affect, nor either affect following the positive tape. Effects of attributional style on affect were partially independent of expectations. Results are discussed in terms of the importance of distinguishing between processes related to positive and negative affect in order to distinguish anxiety from depression.We wish to thank Jennifer Fine, Jennifer Hanlon, Mark Miller, Mark Nelson, and Diana Roscow for their help in collecting and coding data for this study, Jennifer Hanlon and Sandy Thomsen for their assistance in creating the positive tape, and two anonymous reviewers for their helpful comments on a prior draft of this paper.     

Metatraits and cognitive assessment: Application to attributional style and depressive symptoms

This research examined whether attributional style is more closely related to depressive symptoms for some people than for others. In Study 1, depressed patients voicing more explanations for negative events showed (nonsignificantly) higher correlations between attributional style and depressive symptoms. In Study 2, subjects reporting a tendency to ruminate about the causes of events showed stronger relations between attributional style and depressive symptoms. Conversely, subjectslow in attributional complexity exhibited stronger relations of depressive symptoms with positive-event attributional style. We speculated that by asking for ratings of only the single most important cause of events attributional style measures might provide a less adequate sample of the causal thinking of attributionally complex subjects. Study 3 partially supported this reasoning; attributional complexity was not significantly correlated with seeing events as having multiple causes, but it was associated with rating second-most-important causes as distinct from first causes on attributional dimensions. Thus, current attributional style measures and theories might be best-suited to subjects who (a) tend to ponder causes of events but (b) arrive at uniform conclusions about the nature of these causes.For assistance in conducting this research we are grateful to Christina Claffy, Jennifer Fine, Jennifer Hanlon, Mark Miller, Mark Nelson, Jennifer Poirier, Heather Quinn, Diana Roscow Terrill, and Sandra Thomsen. Parts of this research were supported by NIMH grant 1RO3MH47003-01A1 to the second author.     

Anxiety disorders,depression, and attributional style: A further test of the specificity of depressive attributions

This study examined the specificity to depression of the attributional style hypothesized by the reformulated model of learned helplessness. Scores on a modified version of the Attributional Style Questionnaire of patients with dysthymic disorder were compared with those of anxiety disorder patients (social phobic, agoraphobic, and panic disorder) and normal subjects. While dysthymic patients demonstrated more internal, global, and stable attributions for negative events than normals, they did not systematically differ from social phobic or agoraphobic subjects. All groups differed from all the other groups on the Beck Depression Inventory. Analysis of covariance that controlled for depression scores suggested that depression contributed substantially to attributional style, but anxiety disorder diagnosis also exerted a significant effect on some attributional measures. These findings are discussed in terms of their meaning for the reformulated model of learned helplessness and the role of attributional processes in anxiety disorders.Conduct of this study was supported in part by NIMH grants No. 38368 awarded to Richard G. Heimberg, No. 40639 awarded to Robert E. Becker, and No. 39096 awarded to David H. Barlow. We wish to express our appreciation to Debra A. Hope and Debbie Mekos, who assisted in the data analysis. Portions of this paper were presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Boston, November 1987.     

Attributional,life-event,and affective predictors of onset of depression,anxiety, and negative attributional style

This investigation examined (1) the extent to which negative attributional style and life events predict the development of depression and anxiety, and (2) the extent to which measures of life events, depression, and anxiety predict the development of negative attributional style. Sets of questionnaires, including the Attributional Style Questionnaire (ASQ), the Multiple Affect Adjective Check List (MAACL), the Beck Depression Inventory (BDI), the Stimulus-Response Inventory of General Trait Anxiousness (SR-GTA), and the Life Experiences Survey (LES), were administered to 80 undergraduate students on two occasions separated by a 1-month interval, between midterm and final examination periods of an academic semester. Results of hierarchical multiple regression analyses indicated that (1) composite negative attributional style predicted the onset of anxiety, measured by the MAACL anxiety scale, and (2) depression, measured by the MAACL depression scale, and low amounts of desirable life events each predicted the onset of composite negative attributional style.This research was partially supported by the Temple University Research Incentive Fund to the second author. We thank Edward Gracely for his assistance in the data-analytic process.     

Gender and mood as mediators of the relationship between attributional style,daily life events,depression symptoms,and hopelessness

A study was conducted to investigate whether or not the relationship between attributional style, daily life events or hassles, and hopelessness depression is mediated by gender and mood at the time when attributional style is assessed. Measures of attributional style, hassles, depression, and hopelessness were administered, in a prospective design, to 100 undergraduate students on two occasions separated by 1 month. Results showed that the interaction of attributional style, hassles, and gender predicted change in hopelessness levels (p <.05) and that this interaction demonstrated a nonsignificant trend toward predicting change in depression symptom levels (p =.07). The interaction of attributional style, hassles, and time 1 depression scores also demonstrated a nonsignificant trend toward predicting change in depression symptom levels (p =.08), but did not predict change in hopelessness levels. The interaction of attributional style and hassles did not, by itself, predict change in either depression or hopelessness levels. These findings suggest that research investigating relationships between causal attributions for negative life events and depression should consider the potential influences of gender and of mood at the time when causal attributions are assessed. This research was funded in part by a Gettysburg College Institutional Renewal Grant. The author wishes to express his appreciation to Dr. Constance Hammen and two anonymous reviewers for their helpful comments regarding earlier versions of this article.     

Professional commitment and attributional style of medical-college nursing students in China: A cross-sectional study

BackgroundThe persistent shortage of nurses has become a common phenomenon around the world. Nursing students' professional commitment affects their decision to choose nursing as a professional career. However, there is little knowledge about the professional commitment of nursing students, especially its relationship with attributional style.ObjectivesTo explore the professional commitment of nursing students and to identify the role of attributional style on nursing students' professional commitment.DesignCross-sectional study design.Settings and ParticipantsThis study was conducted at three different medical colleges in Jinan, Shandong Province, China and included 1230 nursing students. A total of 1223 valid questionnaires were returned, yielding a response rate of 99%.MethodsThe Professional Commitment Scale and the Multidimensional-Multiattributional Causality Scale (MMCS) were used to investigate nursing students' professional commitment and attributional style. Basic demographic information about the nursing students was collected. Stepwise regression analysis was used to analyze the data.ResultsThe mean scores on the Professional Commitment Scale were 3.54 ± 5.29 (mean ± SD). Professional commitment of first year students was higher than that of second year students. Their residence affected their affective commitment, ideal commitment, and continuance commitment which were the sub-dimensions of professional commitment. Effort and ability attribution positively influenced professional commitment; however, context attribution negatively influenced it.ConclusionsIt is imperative to take effective measures to improve nursing students' professional commitment. Our findings indicated that attributional style had a significant effect on professional commitment; thus, effort and ability attribution need to be emphasized.     

应对方式对脑卒中后抑郁患者的影响

目的 探讨应对方式对脑卒中后患者抑郁的影响.方法 采用一般资料调查问卷、抑郁自评量表(SDS)和简易应对方式问卷对脑卒中患者进行测评.结果抑郁组简易应对方式问卷积极应对维度得分显著低于非抑郁组(P<0.001),抑郁自评量表评分与"积极应对"维度评分呈显著负相关(P<0.001).结论 积极的应对方式可减少脑卒中后抑郁的发生.     

Cognitive and affective features of postpolio syndrome: Illness uncertainty,attributional style,and adaptation

We examined a sample of 58 individuals with postpolio syndrome (PPS). Subjects completed measures of illness severity, perceived support from the medical community, attributional style, illness uncertainty, and general emotional adaptation. We found elevated levels of emotional distress across several parameters of emotional adaptation. Illness uncertainty and generalized negative outcome expectancies were strongly associated with poorer adaptation; disease severity and perceived support from the medical community did not relate to measures of emotional adaptation. Hierarchical multiple regression analyses revealed that illness uncertainty and both stable and global attributions for negative events contributed significant, unique variance to the prediction of psychological distress beyond the influence of illness severity and demographic parameters. In general, individuals with PPS appear to be at risk for problems in adaptation, and specific cognitive appraisal processes appear to play an influential role in the development of these problems. Our findings have general implications for clinical management of persons with PPS.     

Predicting response to cognitive therapy of depression: The role of learned resourcefulness

Thirty-five moderately depressed outpatients were randomly assigned to 12 weeks of cognitive therapy (N = 19), or nortriptyline (N = 16). The patients were assessed on a number of measures before the initiation of treatment to explore the potential of pretreatment variables for predicting treatment response. Both groups of patients showed significant improvement by termination. Improvement did not differ as a function of the type of treatment received. However, an interaction between initial levels of learned resourcefulness, as measured by Rosenbaum's (1980a) Self Control Schedule (SCS), and type of treatment was found. Specifically, patients entering cognitive therapy with relatively high SCS scores did better than patients with low SCS scores. Patients in the pharmacotherapy group showed the opposite pattern: Patients with initially low scores on the SCS did better with medication than did the high scorers.     

Social-cognitive responses to depression and physical stigma

Interpersonal models of depression have received mixed support in experimental studies. Investigations to date have not examined spontaneous subject social-cognitive processes that may mediate social responses to a depressed person. In this study, subjects viewed a videotaped interview of a target who behaved in either a depressed or nondepressed manner, and appeared either physically disabled or able-bodied. Self-report measures of interpersonal rejection and subject mood were collected. Subjects also completed a thought-listing procedure with instructions to write down any thoughts currently and recently experienced. Depressed targets elicited more negative evaluations and fewer positive evaluations from subjects. Additionally, subjects had more thoughts about supporting and offering assistance to the depressed-able-bodied target. Target depression did not elicit more thoughts indicative of social and interpersonal rejection, contrary to predictions. Results indicate that after brief exposure to a depressed person, subjects form many negative opinions about that person.This study is based on a paper presented by the authors at the annual convention of the American Psychological Association, August 1988, in Atlanta, Georgia.     

Agoraphobia,depression, mental health locus of control,and attributional styles

The specificity of an external locus of control and the specificity of attributional biases to agoraphobic and to depressed patients were examined by comparing Multidimensional Health Locus of Control scales (MHLC) and Attributional Style Questionnaire (ASQ) scores for samples of (a) nondepressed agoraphobic patients, (b) nonanxious depressed patients, and (c) comorbid patients. Agoraphobic and comorbid patients externalized mental health locus of control to chance more than did depressed patients. Agoraphobic and comorbid patients attributed good events to more stable causes than did depressed patients. Agoraphobic and comorbid patients also scored significantly higher than depressed patients on a composite measure of internality, stability, and globality ratings regarding causes of good events. Comorbid patients attributed bad events to more global causes than did agoraphobic patients. When globality ratings for good and bad events were summed, comorbid patients scored significantly higher than the other groups.This research was supported by grants from the Haldis and Josef Andresen Legacy and from the Research Institute, Modum Bads Nervesanatorium. We are indebted to project adviser Svenn Torgersen, and to Thorleif Lund, Svein Magnussen, and Helge M. Roennestad for assistance in the preparation of this paper.     

Attributional bias in depression: The role of cue perception

A study was conducted to clarify the nature of the attributional distortions of depressed individuals. Previous research suggests that depressed subjects accept greater personal responsibility for negative outcomes than their nondepressed peers. The present study assessed the extent to which faulty cue utilization is responsible for this depressive attributional bias. The attributions of depressed, nondepressed nonanxious, and nondepressed anxious subjects were assessed. All subjects received failure feedback after working on a task with a confederate whose performance mirrored their own. Depressed subjects, unlike anxious and nonanxious subjects, ignored available attributional cues. Results are discussed in terms of attribution theory and evidence of a depressive attributional style.     

Kangaroo care and postpartum depression: The role of oxytocin

ProblemPostpartum depression occurs in about 10–22% of women after birth and adversely affects their health and the health of their newborn. Kangaroo care is known to have many health-related benefits for both the mother and her newborn.PurposeThe aim of this review was to gather the evidence linking the effects of kangaroo care with postpartum depression, specifically focusing on the proposed underlying mechanism involving the release of oxytocin.MethodThe literature review was conducted by targeting PubMed, CINAHL, and Google Scholar databases. The search terms used were postpartum depression, postnatal depression, oxytocin, oxytocin hormone, postpartum depression, kangaroo care, and skin-to-skin contact.ResultsKangaroo care was found to play an important role in decreasing the risk for postpartum depression. Skin-to-skin contact during kangaroo care was found to trigger the release of oxytocin, which is hypothesized to minimize the risk for depressive symptoms as well as decrease maternal stress. The oxytocinergic system regulates the release of oxytocin, which is an effect that is opposite that which occurs with the human stress response, in which the sympathetic nervous system is activated to release catecholamines in response to harmful or threatening stimuli. The oxytocinergic system regulates calmness, connection, and socialization processes. During kangaroo care, oxytocin blocks the stress response and decreases the circulation of catecholamines, yielding positive outcomes that include maternal stress reduction and prevention of postpartum depression.ConclusionKangaroo care can be used as a non-pharmacological intervention to prevent or decrease the risk of postpartum depression.     

冠心病患者疾病不确定感与生活质量的关系—应对方式及抑郁的链式中介作用

目的: 探讨应对方式及抑郁在冠心病患者疾病不确定感与生活质量间的链式中介作用。方法: 采用疾病不确定感量表、医学应对方式问卷、医院焦虑抑郁量表、生活质量量表对122例冠心病患者进行问卷调查。结果: 疾病不确定感与抑郁呈正相关(r=0.284,P＜0.05),与应对方式、生活质量呈负相关(r=-0.130,P＜0.01;r=-0.144,P＜0.05)。中介作用结果显示,疾病不确定感对生活质量的直接效应显著,应对方式、抑郁在疾病不确定感与生活质量间的独立中介及应对方式-抑郁链式中介作用也显著(Bias -Corrected 95% CI不包含0)。结论: 疾病不确定感不仅对冠心病患者生活质量产生直接预测作用,还通过应对方式、抑郁独立中介及应对方式-抑郁链式中介作用对其产生间接预测作用。